Nurse-led distal radial access: efficacy, learning curve, and perspectives of an increasingly popular access. Does learning by doing apply to both the doctor and the nurse?

BACKGROUND: The distal radial represents an evolution of the standard radial approach. Distal radial arterial access (DRA) in the so-called "anatomical snuffbox" is technically more difficult but offers potential advantages for patients. Moreover, the use of the distal radial would preserve the proximal radial from the risk of arterial occlusion after interventional procedures performed through the radial artery. METHODS: We enrolled 100 consecutive elective patients undergoing cardiac catheterization (diagnostic or procedural). Arterial access to the distal radial was entirely managed by nursing staff supervised by the interventional cardiologist. In this single-centre single-operator experienced study, the same nurse operator performed puncture, wiring, and sheath advancement. RESULTS: The technical feasibility was 89% and the failure rate occurred in the first 50 cases as evidenced by the learning curve. There were no major complications and the rate of minor complications is in line with that of the radial literature. BMI (OR 1.19; 95% CI: 1.03-1.38), non-radial dominance (OR 3.5; 95% CI: 1.04-12.3) and operator's experience (OR 0.59; 95% CI: 0.35-0.99 for every 20 consecutive cases performed) were associated with DRA failures. CONCLUSIONS: The experience is encouraging and beneficial for all staff and patients with a high percentage of technical success and few mild complications.

Provisional stenting or not provisional stenting: seven critical points for bifurcations treatment with a glimpse on left main bifurcation stenting.

Stenting of coronary bifurcation lesions represents a challenge for the interventional cardiologist. A bifurcation lesion could be treated with several techniques. Therefore, it is of paramount importance to decide the strategical approach at the beginning of the procedure evaluating the patient's bifurcation anatomy, the angle between main and side branch, plaque burden at the level of the carina, and size of the side branch. Although it is clear that all bifurcation's treatment techniques have each one their advantages and disadvantages, provisional stenting remains the gold-standard technique, because it leaves the possibility to switch to other technical solutions with optimal angiographic and long-term clinical results. In this review, different tips and tricks for left main and bifurcation stenting are debated.